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Cardiovascular toxicity of Fruquintinib in patients with colorectal and other cancers: A systematic review and meta-analysis
No full textBackground: Fruquintinib is a highly selective tyrosine kinase inhibitor that targets vascular endothelial growth factor receptors (VEGFR) 1, 2, and 3, which play a critical role in angiogenesis and tumor growth. As a novel anti-angiogenic agent, Fruquintinib has demonstrated promising efficacy in the treatment of various advanced malignancies, including metastatic colorectal cancer. However, concerns about its cardiovascular safety have emerged, given that VEGFR inhibition is often associated with cardiovascular adverse events.
Methodology: We conducted a systematic search through PubMed, Scopus, Embase, and Web of Science to identify randomized controlled trials and cohort studies that assessed the safety of Fruquintinib compared with placebo in patients with metastatic colorectal and other cancers. The evaluated outcomes included hypertension, coronary artery disease, cerebrovascular accidents, peripheral artery disease, heart failure, thromboembolism, arrhythmias, aortic dissection, and superior vena cava syndrome. Two independent reviewers screened the titles/abstracts based on predefined inclusion and exclusion criteria, followed by a full-text review of potentially relevant studies. Any disagreements between the reviewers were resolved through consultation with a third reviewer to ensure the accuracy and consistency of the study selection.
Results: Fifteen reports were included in our study. Out of 3832 patients taking Fruquintinib monotherapy, a total of 997 developed hypertension with a pooled estimate incidence of 0.329 (95% CI: 0.248, 0.410; P \u3c 0.001). In comparison to placebo, Fruquintinib was associated with significantly higher odds of developing hypertension (OR: 6.856; 95% CI: 5.071, 9.268; P \u3c 0.001). Compared to Regorafenib, Fruquintinib demonstrated an OR of 1.549 (95% CI: 0.804, 2.983; P = 0.191) for the development of hypertension. Additionally, patients taking Fruquintinib had a pooled estimate incidence of 0.041 (95% CI: 0.021, 0.060, P \u3c 0.001) for thromboembolism development with an OR of 2.092 (95% CI: 0.813, 5.385; P = 0.126) compared to placebo. Other reported cardiovascular side effects included sinus tachycardia, superior vena cava syndrome, peripheral edema, heart failure, myocardial enzymes elevation, and vascular access complications.
Conclusion: Our study found that Fruquintinib is associated with significant cardiovascular risks, with hypertension being the most common adverse event, while thromboembolism did not reach statistical significance. Therefore, close monitoring for treatment-related cardiovascular events should be considered in these patients
Understanding the Burden of Myocardial Infarction and Patient Preferences for Treatment: A Real-World Study Assessing Patients’ Perspectives via an Online Survey
No full textPurpose: Myocardial infarction (MI) remains to be associated with a high risk of recurrent cardiovascular events and disease burden. This study assessed patient perspectives on the burden of disease and treatment in the first year post-MI.
Methods: Data were collected via a self-administered online questionnaire posted on the Carenity patient platform in the United States (10/30/2022−12/30/2022). Only patients who had an MI in the prior year were eligible for inclusion.
Results: A total of 151 patients completed the survey. The majority were men (69%), median age was 50 years, and 38% had an MI within the previous 90 days. Overall, post-MI complications were reported in 44% of the patients, including depression (23%), recurrent MI (7%), and stroke (7%). Follow-up care was provided by general/clinical cardiologists (67%), interventional cardiologists (38%), and general healthcare providers (59%). Most patients (80%) reported involvement in treatment decisions. The number of prescribed medications was considered the main contributor to post-MI treatment burden; approximately 42% of the patients found it tedious remembering to take their medications. The most commonly quoted post-MI treatment goal was recurrent MI risk reduction. Additionally, 73% of the patients considered improving quality of life to be a key goal. Overall, the patients’ emotional well-being, physical well-being, and personal life were particularly impacted by MI. “Stress/anxiety/fear” was the most frequently reported emotion immediately post-MI, and one-third conveyed MI’s negative impact on their employment status. MI impacted household finances in 74% of patients, with 38% losing income.
Conclusions: MI places a substantial burden on patients. Understanding patient experiences post-MI may enhance patient-centered care
Development and validation of clinical criteria to identify familial chylomicronemia syndrome (FCS) in North America
No full textBackground:Familial chylomicronemia syndrome (FCS) is an ultrarare inherited disorder. Genetic testing is not always feasible or conclusive. European clinicians developed a FCS score to differentiate between FCS and multifactorial chylomicronemia syndrome (MCS), a more common condition with overlapping features. A diagnostic score has not been developed for use in the North American context.
Objective:To develop and validate a diagnostic score for North American patients based on signs, symptoms and biochemical traits of FCS.
Methods:Using the RAND/UCLA modified Delphi process, we convened ten US/Canadian physicians with experience recognizing and treating FCS and one adult patient with FCS. The panel developed and rated 296 scenarios describing patients with FCS. Linear regression analyses used median post-meeting ratings to develop score parameters. We tested the score\u27s sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in patients with classical FCS, functional FCS, and MCS from Western University\u27s Lipid Genetics Clinic\u27s registry.
Results:Numerical scores were attributed based upon the following: age, hypertriglyceridemia onset, body mass index, history of abdominal pain/pancreatitis, presence of secondary factors, triglyceride (TG) levels, ratio of TG/total cholesterol, and apolipoprotein B level. Scores ≥60 indicate definite classical FCS; the score distinguished patients with FCS from MCS in a real-world registry (100.0 % specificity, 66.7 % sensitivity, 100.0 % PPV, 95.5 % NPV). Scores ≥45 were very likely to have classical FCS (96.9 % specificity, 88.9 % sensitivity).
Conclusion:Given its simplicity and high specificity for distinguishing patients with FCS from MCS, the NAFCS Score could be used in lieu of - or while awaiting - genetic testing to optimize treatment
Biologics and oral small molecules are not associated with increased major adverse cardiovascular events or venous thromboembolism in inflammatory bowel disease
No full textBackground: Biologics and oral small molecules (OSM) effectively treat inflammatory bowel disease (IBD), but some are linked to higher risks of major adverse cardiovascular events (MACE) and venous thromboembolism (VTE). This study evaluates the MACE and VTE risks in IBD patients treated with biologics or OSM.
Methods: Using the TrinNetX multi-institutional database, we examined MACE and VTE in adult IBD patients on biologics and compared them to IBD patients not on biologics. We also compared IBD patients on OSM to those not on OSM. We performed 1:1 propensity score matching. MACE (myocardial infarction [MI], stroke, and all-cause mortality) and VTE were assessed from 30 days to 3 years after drug prescription.
Results: After matching, IBD patients on biologics had reduced risk of MI, stroke, and all-cause mortality at 1 year, compared to those not on biologics (P \u3c .05). No significant difference in VTE was observed (P = .5). At 3 years, biologic-treated patients had lower risks of MI, stroke, all-cause mortality, and VTE (P \u3c .05). Inflammatory bowel disease patients on OSM showed no significant differences in MI, stroke, or VTE at 1 and 3 years, but had lower all-cause mortality (P \u3c .05). In older IBD patients with at least 1 cardiovascular risk factor, OSM usage showed no significant difference in MI, stroke, or VTE risk compared to nonusers; however, all-cause mortality was decreased at 3 years (P \u3c .05).
Conclusions: Inflammatory bowel disease patients treated with biologics or OSM were not at increased risk of MACE or VTE. Although further studies and longer follow-up periods are needed to confirm these findings, our results provide reassurance regarding the safety of these medications in IBD
Clinical outcomes of roux-en-Y gastric bypass versus medical therapy in type 2 diabetes mellitus: A systematic review and meta-analysis
No full textBackground:The growing incidence of obesity has led to a proportionate rise in type 2 diabetes mellitus (T2DM) and its associated complications. We aimed to compare the long-term outcomes of Roux-en-y Gastric Bypass surgery (RYGB) and conventional medical management in T2DM obese patients.
Methods:PubMed, Google Scholar, and Clinicaltrial.gov were searched from inception to September 2023. Randomized Controlled Trials (RCTs) and cohort studies were included in this meta-analysis. The primary outcomes were the T2DM remission at 1, 2, 3, and 5 years and the accomplishment of the ADA composite triple treatment goal. The revised Cochrane risk of bias tool 2.0 and New-Castle Ottawa scale were used to assess the quality of the studies. This meta-analysis was registered prospectively on PROSPERO CRD42023466324.
Results:Of the 3,323 studies yielded from our initial search, 22 were included in this evidence analysis, with 5,176 total patients (1,984 and 3,192 patients in RYGB and conventional medical management groups). A significant increase in the accomplishment in the ADA\u27s composite triple treatment goal was observed in RYGB group as compared to the conventional medical management group (RR 2.41, 95% CI 1.39-4.15, p-value 0.002, I2 35%). Diabetes remission was a clinically successful outcome after 1, 2, 3, and 5 years of the RYGB surgery in the patients (1 year; RR 4.74, 95%CI 2.46-9.12, p-value \u3c 0.00001, I2 0%, 2 years; RR 8.95, 95% CI 1.71-46.71, p-value 0.009, I2 92%3 years; RR 18.18 95%CI 7.57-43.62, p-value \u3c 0.00001, I2 0%, 5 years; RR 0.22, 95% CI 2.31-16.75, p-value 0.0003, I2 = 71%).
Conclusion:The pooled analysis of the given data concluded that the RYGB surgery was more effective in treating T2DM in patients than conventional medical management.
Supplementary information:The online version contains supplementary material available at 10.1007/s40200-024-01526-z
Exploring nurses\u27 personal and professional values and care quality: A convergent mixed-methods analysis
No full textBackground: Professional standards and the Codes of Ethics from the International Council of Nurses and American Nurses Association are frameworks driving professional practice and are linked to positive patient and nursing outcomes.
Objective: To describe qualitative themes extracted from narrative responses on how nurses\u27 personal values influence nursing care and converge with quantitative results assessing personal values, professional values, and the practice environment, a key component of nurse satisfaction and subsequent care quality.
Methods: A convenience sample of nurses across 19 sites within a large nonprofit healthcare system was surveyed. Quantitative measures included the Short Schwartz\u27s Value Survey for personal values, the Nurses Professional Values Scale-3 for professional values, and the Practice Environment Scale of the Nursing Work Index, assessing practice settings. Concurrently, nurses were asked, How do your values influence the care you provide? Responses were examined using a descriptive qualitative method for thematic analysis.
Results: The sample included qualitative (n = 408) and quantitative (n = 671) responses. Six qualitative themes emerged: patient-centered care, professionalism/integrity of practice, advocacy, dissonance, golden rule/ethics of reciprocity (religiosity), and perseverance. Themes converged with the mean personal values of achievement, self-direction, universalism, benevolence, tradition, and conformity, and diverged with hedonism, security, and stimulation. All professional values factor means and work environment subscale means converged.
Conclusions: Findings highlight convergence and divergence between qualitative and quantitative responses from nurses, offering new insights into the themes of dissonance, perseverance, and religiosity. The findings present valuable opportunities to enhance recruitment and retention strategies
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No full textIncreased Depressive and Anxiety Symptoms Predict Increased Severity of Functional Impairment After Five Years: A Nationally Representative Retrospective Cohort Study
No full textPurpose: Performing self-care and domestic life tasks are key aspects of functional independence for older adults. While both depression and anxiety symptoms are correlated with increased functional limitation, these disorders are often studied separately, despite frequent co-occurrence and plausible interaction, and without the consideration of social health. This study examined the impact of comorbid depressive and anxiety symptoms, controlling for social participation and loneliness, on severity of functional limitation in a nationally representative sample of older adults to improve patient-centered care.
Methods: The National Social Life, Health, and Aging Project (NSHAP) Rounds 2 and 3 data were utilized. Primary outcomes were self-reported difficulty with activities of daily living and instrumental activities of daily living. All analyses were weighted for Round 2 to account for NSHAP sampling design.
Results: Approximately one-quarter of respondents documented either depressive or anxiety symptoms, with 9.4% documenting both. Those with both depressive and anxiety symptoms reported the greatest number of functional limitations and greatest difficulty with tasks when assessed after 5 years. Using multivariate linear regression, poorer mental health status and increased comorbidity burden significantly predicted severity of functional limitation. While loneliness was associated with slightly worse function, increased social participation appeared to be a protective factor.
Conclusions: These results build on existing literature calling for a more holistic assessment of health – physical, mental, and social – and further emphasize the need for mental health interventions as an avenue to increase functional independence in older adults to improve patient experience and patient-centered care
Dreyer Heartbeat, 1992 April-May
No full textDreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.https://institutionalrepository.aah.org/alldocuments/1902/thumbnail.jp